UMBRELLA (Employed)

Register as Umbrella employed: online form

Umbrella (Employed)

Register before 12pm on a Friday to be paid the same week. Please note we cannot process payments for individuals who register after 12pm until the following week. Anyone registering after 12pm will be paid the following Friday.

You will need to provide ID and proof of your right to work. It is essential that we receive this BEFORE you are due to receive your first payment from us

Please complete and submit this form as soon as possible. Until we have processed your application and received your ID papers you cannot enjoy the benefits of being an Exchequer Solutions employee.

Complete the whole form if you can, but YOU MUST COMPLETE ALL AREAS OF THE FORM MARKED WITH * before we can accept your application. Supporting documents can be sent via email, MMS, fax or post.

1. Your Details

Title - enter MR, MRS, MISS, MS or other title

GenderMaleFemale

First Name:

Middle Name:

Surname:

House Name or No.

Second line of address:

Town:

Postcode:

Telephone No. (Home):

Mobile Number:

Fax number:

E-mail:

We prefer to send payslips via email – if you prefer to receive them via post please tick here

Date of Birth: (dd/mm/yyyy)

National Insurance Number: eg. AB123456C

We are required to check that you are eligible to work in the UK.Please confirm whether you are a:

British citizenCitizen of other European Economic Area EEA1) countryCitizen of other country

2. Password

When we contact you we may ask you to confirm your password as part of security checks – please do not let anyone else know your password.

My password is

3. Your Bank or Building Society Details

Name of Bank or Building Society:

Branch Address:

Account Holders Name(s):

Sort code: eg. 001122

Account Number: eg. 01234567

Reference No. (For Building Society Accounts):

4. Your Job Title

Job title/profession

Your present circumstances

Read all the following statements carefully and select the letter from below that applies to you.

A – This is my first job since last 6 April and I have not been receiving taxable Jobseeker's Allowance, Employment and Support Allowance or taxable Incapacity Benefit or a state or occupational pension

B – This is now my only job, but since last 6 April I have had another job, or have received taxable Jobseeker's Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a state or occupational pension

C - I have another job or receive a state or occupational pension.

Student Loans (advanced in the UK)

If you left a course of UK Higher Education before last 6 April and received your first UK Student Loan instalment on or after 1 September 1998 and you have not fully repaid your Student Loan, enter 'X' in box D. (Do not enter ‘X’ in box D if you are repaying your UK Student Loan by agreement with the UK Student Loans Company to make monthly payments through your bank or building society account.

5. Agency Details

Name of Employment Agency / Company:

Agency Branch:

Telephone No:

Fax No:

Contact Name(s) at Agency / Company:

Start Date:

(If you are experiencing validation errors with the date fields, please try again and leave the date field blank)

6. Holiday Pay

Please select below how you would like your holiday pay to be received:

If you do not tick either box we will retain your Holiday Pay and pay it to you when you take holidays.

7. Agreement to Terms

I understand that Exchequer holds information about me for certain purposes, including (but not limited to), confirming entitlement to work in the UK, administering personnel and pay records and otherwise as reasonably required to operate its business. I understand that I can request access to this information (subject to applicable exemptions) by contacting Exchequer Solutions at the address below.

By signing this application form, I am consenting to the processing of personal data (and sensitive personal data) as described above. Further, I agree to such data being released to third parties (such as insurance providers) where necessary for the foregoing purposes.

By signing below, I consent to Exchequer Solutions providing references on my behalf to future employers or third parties.

I consent to the checking of my personal data and qualifications to work in specific areas, where these are required for the purpose of compliance with legislation.

I agree that all the information supplied on this form is correct and true to the best of my knowledge.

I agree to keep Exchequer Solutions informed in writing of any changes in my personal details, contact details and any changes in my personal circumstances which might affect my immigration status and eligibility to work in the UK and to supply any such information on request.

I agree to provide on request documents and information which will enable Exchequer Solutions to make any necessary statutory checks on my eligibility to work in the UK.

Please select this box to confirm you have read and agree with our terms and conditions.

For further information please contact Exchequer Solutions on 01244 500195.

8. Equal Opportunity Monitoring

We are an equal opportunity employer. The aim of our policy is to ensure that no job applicant or employee receives less favourable treatment on the grounds of race, colour, ethnic or national origin, religious belief, political opinion or affiliation, sex, marital status, sexual orientation, gender reassignment, age or disability, or is disadvantaged by conditions or requirements which cannot be shown to be justifiable.

All employees are given equal opportunity and are encouraged to progress within the organisation.

We are committed to an ongoing programme of action to make this policy fully effective. To ensure that this policy is fully and fairly implemented and monitored, and for no other reason, would you please provide the following information:- (Please note – the information below is requested but is not mandatory).

1) Ethnic Category: The following categories are based on those recommended by the EHRC. Please note the ethnic questions are not about nationality, place of birth or citizenship. UK citizens can belong to any of the ethnic categories indicated.

Please tick the box below which best describes the ethnic category to which you belong: